Leading the Way to Safety
(7/20/11)
Activist and author Kathleen Bartholomew explains how a culture of patient safety also provides a safe haven for nurses to speak out about the prevalence of medical errors at their facilities.

Having the ability to detect medical errors can help hospitals go a long way toward establishing a culture of safety. But being able to confront mistakes, and have open discussions about preventing future occurrences, is really the key to maintaining an environment that is safe for patients over the long haul, according to nurse activist and author Kathleen Bartholomew, RN, MN.

For health care organizations to succeed in the coming years, Bartholomew believes that nurses will need to take on a leadership role in ensuring that patient safety is always a first priority in our care environments. 

"A big part of our job as nurse leaders is to know what is really happening out on the floors, and to deal with that reality," she says. "If we can recognize interpersonal issues as they occur, then we can take steps to intervene and create a healthier work environment, before poor working relationships affect our patients."

Bartholomew believes that poorly managed stress amongst the hospital staff can place patients at a significantly higher risk for medical errors. "When a nurse becomes isolated, stressed, or burned out, and there's no managerial support or solidarity with his/her peers, it's easy to imagine a situation where a patient could be inadvertently harmed," she says. 

"When staff members are unhappy and upset, they can't think straight. And that's a breeding ground for dangerous medical mistakes." 

To compound the problem, nurses are often afraid to speak up about safety breaches they've observed, because they believe they may be ostracized or retaliated against by others who are vested in the status quo.

"The number one error in health care today is one of omission," says Bartholomew. "Nurses often won't confront instances of sub-standard care, because they don't want to imperil their relationships with other staff members. But it's up to us to always put patients at the center of everything we do, even if that means going against the herd."

One of the most important ways nurse leaders can improve their facility's safety culture is to break down hierarchies of power, to give everyone a voice and a responsibility to uphold quality care standards. 

"If you can disseminate the power in your organization and make everyone feel equally accountable and equally important, your staff will be more likely to work together to solve their problems and improve the care environment for patients," Bartholomew says.

"Patient safety starts with the staff knowing they are safe in a collegial team. Everyone must feel that they can speak out about what's really happening at their hospital and address issues that impact patient care and teamwork, without fear of reprisal. That's the only way to uphold a culture of safety: a hospital will never be safe for patients, until it is safe for caregivers."

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